The Quackometer

One of the side effects of the BCA vs Chiropractic libel case is that there are a growing number of people who now realise that Chiropractic is bogus*. Even though Simon Singh may well have suffered a set back from a judge who according to the law can define words as he sees fit, we are now seeing increasing exposure to the bogus* practices of the chiropractic trade.

One way to show the ridiculousness of the legal decision and of chiropractic would be to have a little blog carnival on the bogus* nature of chiropractic claims and practices, and so I suggest that sceptical bloggers and writers help out by doing the following…

1. Find a chiropractic claim from an association or practitioner and examine the evidence for it critically. Look at Cochrane reviews (if they exist), papers and the basic science behind the claims. Write to the claimant involved and ask them for their evidence for their claims.

2. If the evidence for effectiveness is lacking, call it a bogus* treatment.

3. Let me know what you have written and I will do a round up in a few weeks. Email me or twitter me @lecanardnoir.

4. Spread the word. Twitter like crazy.

I am on hols at the mo, so can I suggest all entries are emailed to me (see my ‘about’ pages) so that the carnival will appear y June 5th.

I think with not much effort we could turn the chiropractic google space into  a web of critical articles. That would be a small step in the right direction.

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* deliberate deception not implied.

Labels: British Chiropractic Association, chiropractors, Simon Singh

The University of Oxford recent completed a report into the comparative costs of defamation proceedings across Europe. Its conclusions were that the costs of libel proceedings in England and Wales are about 140 times higher on average than those found across Europe. The reasons for this boil down the large number of lawyers that get involved, the length of the proceedings, the adversarial nature of English law, and the take up of Conditional Fee Arrangements (CFAs), “no win no fee”.

The result of this is that the legal costs involved are likely to be hugely disproportionate to any potential damage done. Defending a case of libel, even if the damages only amount to a few thousand pounds, could result in the losing party facing legal bills of six or seven figures.

The specifics of English libel law make the situation even worse. The entry costs to make a libel claim can be very low. Conditional Fee Arrangements allow a lawyer to take on a case where they will only receive payment if they win. And because of the risks involved their fees may well be double that if there were no CFA. There is also a double whammy in that the legal barriers to starting libel proceedings are very low. All the complainant has to do is show that they have some sort of reputation worth defending and that the accused party has made a statement that has defamed them. There is no requirement to show that this statement is untrue or not fair comment. Nor indeed is there indeed any requirement to show that you have suffered any loss.

The effect of this is that English libel law can be easily used to silence criticism. The complaining party essentially has to take no risk of costs and take on no burden to prove their case. The huge risks and burdens of proof are passed almost entirely to the defendant. So what should someone do when faced with a libel claim against you? A game theory approach might suggest that, since you can never be certain of success, no matter how well justified you might believe yourself to be, there can only be downsides by defending yourself and that you should seek to apologise and settle as soon as possible, regardless of the strength of your case. Defendants may well end up having to pay large amounts of money no matter if they win or lose.

This Oxford report talks about how such a situation has serious free speech issues in the British press. Newspapers are heavily dissuaded from defending libel claims, regardless of their merit. This undermines the role of the press and results in self-censorship where articles criticising wealthy or powerful interests may be dropped or watered down. Our libel laws were essentially created to enable the powerful and the elite to preserve their reputations against the tittle-tattle of the press. As the press grew more powerful, CFAs were brought in to allow ordinary people to take on the press when they do not have access to large amounts of money.

In 1995 Lord Woolf, identified three problems with libel law,

a. litigation is so expensive that the majority of the public cannot afford it unless they receive financial assistance;
b. the costs incurred in the course of litigation are out of proportion to the issues involved; and
c. the costs are uncertain in amount so that the parties have difficulty in predicting what their ultimate liability might be if the action is lost.

CFAs were brought into address point a. However, it would appear that they have also exacerbated the other problems. Whilst CFAs have allowed the less powerful to take on the more powerful, they have then, in the conclusion of the report, denied justice to the defending side.

The report suggests that CFAs and the libel law are not compatible with Article 6 – Access to Justice - and Article 10 – Freedom of Expression -  of the European Human Rights declaration. It states,

Based on those findings it is therefore reasonable to develop the following hypothesis: The CFA scheme increases access to justice for litigants bringing CFA-based defamation claims while eliminating financial incentives and thereby denying access to justice to media outlets, which leads to an interference with the right to freedom of expression. Such a hypothesis must be considered in terms of the ECHR’s Article 6 regarding the right to access justice and Article 10 regarding freedom of expression.

The huge and disproportionate costs of defending libel, the unpredictability of outcome and the burden of defence have all hit hard upon one of Britain’s best science writers. This week we have seen Simon Singh having been placed in a rather kafkaesque position where he is now unable to defend himself against a libel charge as he has been told he must prove something that he clearly does not believe to be true. Libel law hinges around the defamatory meanings of words and the judge in this case has decided that the word ‘bogus’ can only mean ‘fraudulent’. Due to the strict requirements of the pre-trial hearings, Simon will now not be able to defend what he wrote under any reasonable terms. Simon has made it quite clear, and the article made it clear too, what he meant by ‘bogus’. But he will not be able to put that case forward to the judge because of the humpty dumpty nature of the courtroom.

The British Chiropractic Association brought the charge of defamation against Simon Singh after an article appeared in the Guardian criticising the lack of evidence for many chiropractic practices and how the BCA continue to promote such treatments when the scientific evidence appears to be so low. Of course the BCA may well have some evidence that is not readily available, they may be unaware of the lack of evidence, but the judge has ruled that Simon meant they are being fraudulent in promoting these ‘bogus’ treatments.

Already the BCA have succeeded in that the discussion now going on is about the various meanings of the word ‘bogus’ and not about the effectiveness of chiropractic treatment. If Simon decides to appeal then we could see many more months of wondering what ‘bogus’ means to the man on the street. Costs will escalate rapidly.

With such a blatantly unjust set of laws, those who seek to bring defamation cases against individuals must surely already be on the losing side of morality.  The costs for the defendant can only be crippling for the average person. And libel is about reputation, and the clearing of reputations if they have been defamed. Libel laws should not be about exacting revenge, huge cash awards and legal fees, and the silencing of criticism – and that is exactly what they are in the UK. Of course there is a need for defamation laws. But when there are straightforward alternatives to the lumbering and unpredictable giant of the courtroom, then these should be taken. Clarifications, debate, discussions of evidence are still available to the BCA.

And let us remember what this libel claim is about. It is not about claims that some MP or businessman had their fingers in the till. Nor is it about a footballer allegedly seen coming out of a nightclub with someone other than their WAG. This is about a award winning science writer penning a comment piece in a respectable paper about a matter of public health. It is questioning the amount of evidence for an alternative and doubtful practice and highlighting the unspoken dangers of such treatments on children. It is exactly the sort of article that our papers ought to printing and is undoubtedly an important matter of public interest. The central point of the article is that chiropractors promote their trade for children’s ailments, such as asthma, when there is no plausibility that their techniques work, poor evidence that they do, and all with significant risks of harm. That is a charge that a responsible profession would answer.

Simon Singh may well have made an unfortunate choice of words or may well have been unlucky with the trial judge. The article he wrote could have easily been slightly edited to get around the current problems and the substantive criticism he made of the chiropractic trade could have remained. And this highlights how unjust this whole process may be. If the BCA want to clarify that they are not fraudulently promoting treatments and that they believe they work (for whatever reason) then they could have written a letter to the paper. Even better, they could have presented scientific evidence of their efficacy – if it exists. But by pursuing Simon Singh, they are using unjust laws to potentially financially cripple a critic.

Simon will be deciding over the coming days if he wishes to appeal. The logic of current English libel law would suggest he should not. But I know that Simon is a principled man and that the principles involved here are well worth fighting for. The libel law is a serious threat to free speech and it is a serious deterrent to engage in debate where vested interests may wish you to remain quiet. My guess is that in the end this will have to be decided by Europe. The UK government appears to be slow to act. One reason may well be that the main victims of this injustice appear to be the press and correcting this may well not be in the best interests of politicians. One only has to look at the news today to see how the press and MPs are not the cuddliest of friends. Also, so many MPs come from a legal background, and lawyers are the major winner in this mess.  However, it is an injustice that effects us all and it may well take a lone and principled campaigner to do something about it. Perhaps Dr Simon Singh is that man.

Labels: British Chiropractic Association, chiropractors, Simon Singh, the law

 Yes. Let’s be clear. Over a hundred people, sat through several hours of discussion about funnel plots and publication bias, baseline manipulation, subgroup analyses and inappropriate controls – and it was huge fun. Ben was describing how pharmaceutical companies manipulate trial data in order to make their products look better than they are. It was a lecture he normally gives to medical students in London and we had the pleasure of it whilst drinking Speckled Hen.

I was one of the organisers, along with up-and-coming comedian Iszi Lawrence, keen sceptic Justin and comedy promoter, Andi Currie, and the size of crowd and response surprised us – so apologies to those who could not get in. We are working on it. When I was a student, we went to evenings in a small room above a pub in Kings Heath, Birmingham, to sit through a crappy little comedy club run by an unknown Frank Skinner and hear jokes about rubbing the breasts of the Madame Tusauds waxwork of Prince Anne. Now people are coming out to pubs to hear talks about rational thought, sceptical enquiry, quackery, pseudoscience and conspiracy theories. Scepticism is the new comedy is the new rock and roll.

Oxford is not the first group like this. London has been going for a number of years now and is used to huge crowds. In the UK, there are now groups in Edinburgh, Leeds, Birmingham and Leicester, with new groups being set up in other cities as we speak. Across the world, similar groups are cropping up in Australia, Canada, South Africa and the USA.

Why should this be so? There are perhaps many reasons. One simple explanation may be that comedy and scepticism appear to be good bedfellows. There are now many entertainers and comedians who take a distinct sceptical line, including Tim Minchin, Derren Brown, Mark Thomas, and Dara Ó Briain. Indeed, comedy king Robin Ince organised a phenomenally successful Christmas show, Nine Lessons and Carols for Godless People: A Rational Celebration for Christmas which seamlessly combined the scathing sceptical wit of Ricky Gervais with the arch rationalism of Richard Dawkins. Yesterday, James Randi’s first London TAM meeting sold out its hundreds of tickets in just a few hours, taking the organisers by complete surprise. So, one simple explanation is that laughing at quacks and cranks might just be good honest fun.

But I think there might be more than that. Remember, Ben’s talk was about the abuse of statistics by drug companies. It was serious stuff and shocking. The numbers trotted out of the deaths caused by vitamin pill pushing quacks and deceitful pharmaceutical company marketing departments were extraordinary. Ben made the point of highlighting how immune we are to feeling shocked by such figures – but torture a kitten and we are up in arms. And yet, there was a real sense of engagement and humour. The feedback was that people were thoroughly enjoying it. And I think this is because that organisations like Skeptics in the Pub create shared experiences of thoughtful dialogue in a way that is hard to find in today’s media-led environment. If you have been trained in science and enjoy reading popular science books and no longer work in a University environment, for example, there are few opportunities to discuss these ideas. (Interestingly, there were only three Oxford undergraduate students there after a head count). Television contains close to zero science content. Newspapers appear to deliberately misrepresent science in order to create sensational or politically loaded stories. And our celebrity obsessed culture has our friends down the pub talking about the split up of some bird with big tits with some bloke with big pecs. And we are used to biting our lips at dinner parties, weddings and at work, where friends and colleagues appear unashamed to tell us how much they believe in homeopathy, star signs and ‘spiritual’ things. These pub chats supply a huge and welcome antidote – there really are people in the world who are not completely batshit – lots of them.

Skeptics in the Pub Oxford began with a meeting between the four organisers in the Eagle and Child, an Oxford pub more famous for earlier drinkers, the Inklings, where Tolkien and C S Lewis would read to the group from their latest writings, drink heavily, and then argue about who was the hardest, Aslan or Gandalf. (I am personally waiting for the film franchise fusion to take place, in the style of Aliens vs. Predator, to see on onscreen resolution of this ultimate fantasy question.) So, maybe we are seeing a revival of talking about interesting things in pubs. If you want to to, go along to your nearest sceptics talking and drinking club and have a rational pint, I am sure they will be pleased to see you.

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Our next meeting in Oxford is with Simon Singh (Monday, June 8 at 6:30PM). This should be another crowd puller – get there early. Simon is also the subject of a special Skeptics In the Pub meeting in London on Monday (The Penderel's Oak) where Nick Cohen, and other prominent sceptics, will be holding a Public Support meeting to help Simon in his recent troubles with the British Chiropractic Association.

Subject: Public Meeting, London, 18 May 2009

I understand that Simon Singh will announce whether he will appeal on Monday 18 May 2009 at a public support meeting to take place in London at 6.30pm.

The venue will be the Penderels Oak, the usual meeting place of London Skeptics in the Pub.

As well as Simon Singh, the leading UK journalist Nick Cohen will be speaking. Other speakers are currently being confirmed.

For more, see: http://www.facebook.com/l/;http://jackofkent.blogspot.com/2009/05/bca-v-singh-update-and-roundup.html

Prince Charles' company, Duchy Originals, has today been told by the Advertising Standards Authority to stop making misleading and untruthful claims in its advertising and to not make claims for its detox products that it cannot substantiate.

If you haven’t managed to escape the winter sniffles, look no further than our new Echina-Relief Tincture, which offers natural relief from cold and flu symptoms.

 

This week were celebrating the launch of our brand new Herbal Tinctures range. Our Echinacea, Hypericum and Detox Tinctures provide alternative and natural ways of treating common ailments such as colds, low moods and digestive discomfort.

From the time I received the email to the time it was in the hands of the ASA was probably less than 120 seconds (a record I hope) thanks to their online complaint submission form. Investigating the claim took a little longer but now we can see the results of that investigation. I had complained that the company would not be able to substantiate the claims that these tinctures were  effective.

Previously, Andrew Baker, the head of Duchy Originals, had said of the detox tincture, “It is not – and has never been described as – a medicine, remedy or cure for any disease”. It was my view that the email advert made explicit claims to be a “medicine, remedy or cure” by saying that it provided, with the other tinctures, “natural ways of treating common ailments such as colds, low moods and digestive discomfort.”

The ASA agreed with me that the advert was misleading and upheld one complaint against each of the three products mentioned. Specifically, the advert breached advertising codes on truthfulness, substantiation  and the advertising of health and beauty products and therapies, and medicines.

This is not the first time that Duchy Originals has been censured over its tincture range. As I reported earlier (Duchy Originals Pork Pies), the Medicines and Healthcare products Regulatory Agency (MHRA) had told Duchy Originals to stop making claims of efficacy for their products that cannot be substantiated after a complaint was made by the science group Voice of Young Science.  The Advertising Standards Authority have told me that the MHRA will also receive a copy of their adjudication. What can we expect  the MHRA to do given these blatant acts of disregard for medicines advertising?

Well, my guess is nothing. For the real villains here, in my opinion, are the MHRA themselves. In their response to the complaint, Duchy Originals stated that two of the three products, Echina-Relief and Hyper-lift tinctures, were licensed by the MHRA under the Traditional Herbal Medicines Directive. This directive allows license holders to make claims about their herbal remedies if the product has been ‘traditionally’ used. The rules are quite daft. In order to get a license, the applicant has to show that the product has been in use for 30 years in the EU, or 15 years in the EU and 15 years elsewhere. So, the product could have been ‘traditional’ in the same sense that ABBA is ‘traditional’ European music. There is no need to show there is any evidence for the product.

This is quite a shocking state of affairs. The MHRA have a mission to “safeguard the health of the public by ensuring that medicines and medical devices work, and are acceptably safe”. By taking on the Traditional Herbal Medicines Directive, the MHRA have undermined their reason for being because traditional use is no substitute for evidence when looking at what medicines work and are safe. In this regulatory regime we are subjugating evidence to the beliefs of any group of cranks (or fraudsters) who have stated that a herb can treat their illnesses.

So, could Duchy Originals have defended their claims with good evidence? The best place to look is to see what Cochrane reviews say about these herbs. The Echina-Relief tincture is probably best reviewed in a study entitled “Echinacea for preventing and treating the common cold”. The author’s conclusions are:

Echinacea preparations tested in clinical trials differ greatly. There is some evidence that preparations based on the aerial parts of E. purpurea might be effective for the early treatment of colds in adults but the results are not fully consistent. Beneficial effects of other Echinacea preparations, and Echinacea used for preventative purposes might exist but have not been shown in independently replicated, rigorous RCTs.

In other words, if there is a positive effect, it will be dependent on the specific preparation and product, and we have no great evidence that even this might be so. As far as I can see, no such evidence exists for the Duchy Originals product. Evidence for effectiveness is pretty slim and unconvincing.

How about the Hyper-lift tincture? The review on “St John's wort for major depression” might give us some clues.  The review of evidence is quite positive, but there is a major complication. Cochrane reports that “trials from German-speaking countries reported findings more favourable to hypericum”. Is it plausible that German speakers get a greater benefit, or are we seeing a greater placebo effect in countries where the treatment is more popular? Whatever, we might conclude, Cochrane is cautious - “St. John's wort products available on the market vary to a great extent. The results of this review apply only to the preparations tested in the studies included”. We cannot use these reviews as evidence that Prince Charles’ products work – even though his family is German.

Looking at the ‘non-medical’ tincture – the detox tincture – this is the most ridiculous of them all. It claims to be a “a food supplement to help eliminate toxins and aid digestion.”. However, the company is unable to name any toxin that is actually removed by this product and what the evidence for this is. It is pure pseudoscientific bullshit.

This inadequacy of evidence is important. The MHRA give themselves a get out clause for licensing these products that they have not used in these cases. They can refuse a license if the claims are not plausible. Given that the best evidence to date on these products is pretty cautious and specifically excludes products that are not explicitly tested, the plausibility that a company can just magic a product up and expect it to work is very low. It is not plausible that a pharmaceutical company could do this. It is not plausible that Prince Charles could either.

We have a situation where the government is now licensing medicinal products on the flimsiest of evidence. The idea that we can expect a product to work on the basis that someone in Europe in the past few decades have been gullible enough to buy the product is obviously daft. And I would suggest that the MHRA have obviously not been forceful enough on the requirements of their license. They state that the licensee must use very specific wording when making claims – that the product is a “traditional herbal medicine for use on [specific indications] exclusively based upon long standing [sic] use as a traditional remedy”. The stupidity of Duchy Originals is that they did not stick to this wording. The MHRA are supposedly convinced that the public can then interpret the wording as meaning that there is no real evidence for effectiveness. But we know that it is a common quack trick to suggest a treatment has ancient origins in order to sell their product. The MHRA have played right into quack hands.

And so when the MHRA give a license, we then are left with organisations like the impotent ASA to police it. I see little evidence of the MHRA taking a tough stance. I have one complaint against a blatant breach of rules that is now over a year without any action and despite requests for statuses on progress. The MHRA appear unconcerned about quackery claims. This also has to be looked at in the knowledge that we know that Prince Charles has written lots of letters to the MHRA and meetings have been held at Clarence house before these new directives came in. We are not allowed to know the contents of those letters.

The importance of this appears to need to be explicitly stated. We currently have a significant health risk in the form of swine flu. This risk may well not materialise quickly. Flu tends to strike in the winter months. The coming months may well see pockets of infection establishing across the world. Come the winter, we may then see this strain striking out in earnest, maybe even with some more deadly mutations. When our government explicitly licenses companies to make claims that their quack remedies can prevent or treat flu without evidence, they undermine their ability to issue meaningful, evidence-based and life-saving advice.

The MHRA, in taking on this role of licenser and legitimiser of quackery, undermines its ability to be an authority in this most important area.

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Coverage

Marketing of Prince’s remedies banned  - FT

Prince firm's advert 'misleading' – BBC

Prince of Wales's Duchy Originals herbal remedy claims were 'misleading' - Telegraph

Labels: Duchy Originals, MHRA, Prince Charles